Search

Aim: Evaluate the additional burden of centralised neonatal care on families of extremely preterm infants cared for away from their planned hospital of birth. Methods: Retrospective cohort study using national data for infants 23+0 to 27+6 weeks of gestation admitted for neonatal care from 2011 to 2016. The number of transfers on the first day of life (potential maternal–infant separation), time away from the maternal booking hospital (BH) and distance from the maternal residence were quantified. Results: Of 14 719 included infants, 2803 (19%) underwent postnatal transfer on the first day of life. A total of 8622 (59%) infants were cared for away from their BH for a median of 39 days (interquartile range [IQR] 15–69), 30% spending >60 days away over a median of two episodes (range 1–12). Median return road travelling distances for parents to their local BH was 13 km (IQR 8–26), but this increased to 74 km (IQR 32–148) for those cared for in a non‐BH. Conclusion: Centralised neonatal care improves infant outcomes but introduces additional burdens on the families of extremely preterm infants cared for away from their BH. Additional support, including accommodation and financial aid, could help minimise the impact on these families, facilitate family integrated care and improve parental wellbeing. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to evaluate an early discharge programme with video consultations for preterm infants. Methods: A homecare programme for preterm infants was developed. Prospective data on readmissions, length of stay, growth, breastfeeding rates, and parent self‐reports about satisfaction were collected from April 2021 to August 2023. Additionally, retrospective data were collected from the Norwegian Neonatal Network Central Database from 2020. Results: Preterm infants, 72 and parents, 128 were included. The infants were discharged from the hospital at a median of 35 + 6 (34 + 0–42 + 4) weeks postmenstrual age. The median length of stay in the program was 18 days (3–37). There were four readmissions. The Z‐score of infant weight slightly increased during the follow up, with a mean of 0.16. By discharge, 75% of the infants were exclusively breastfed. Growth and breastfeeding rates were in line with retrospective data (85 infants). The response rate of the parents to the survey was 61 (52%). Overall, the parents (n = 54) were highly satisfied (96%). The video consultations contributed to ensuring parents to feel safe in caring for their infant at home. Conclusion: Follow up by video consultations is a viable healthcare service for preterm infants, the infants' growth is sufficient, breastfeeding rates are maintained, and parents feel safe and satisfied. [ABSTRACT FROM AUTHOR]

The article discusses the benefits of early skin-to-skin contact (SSC) between mothers and very preterm infants in the delivery room. The study conducted from 2012 to 2015 found that SSC improved mother-child interaction, bonding, and reduced maternal depressive symptoms. The results also showed that SSC brought the mother-child interaction of preterm infants close to normal levels. Since 2015, delivery room SSC has been implemented as standard care for all infants in the center, regardless of gestational age and birthweight. The article emphasizes the importance of close collaboration between the neonatal team and the mother for successful implementation of SSC. [Extracted from the article]

Aim: Blood component transfusion is a common intervention in the neonatal intensive care unit (NICU). Parents consent on their babies' behalf. This study aimed to explore parents' understandings and experiences of consenting and the subsequent blood transfusion. Methods: A "low inference" qualitative descriptive semi‐structured interview approach was utilised. Grounded theory was employed. Parents described their memories of babies' transfusions, their responses to the consent process and assessed the written information they were given. Results: A purposive sample of 17 parents whose babies required blood transfusion in the NICU participated. Parents talked about their initial fears of transfusion, later replaced by confidence in the process and results of transfusion and trust in the healthcare professional team. The main themes elicited by the interviews were parents' expectations and outcomes of transfusion, parents' prior and current opinions of transfusion, parents trust in healthcare professionals and how parents would like to receive information about transfusions in the NICU. Conclusion: Parents in our study trust information from the healthcare professionals caring for their baby and would like more specific information about how blood transfusion will impact their baby, in a variety of means. Parents felt that blood transfusions were beneficial for their babies. [ABSTRACT FROM AUTHOR]

The article discusses the importance of family-centered care in Neonatal Intensive Care Units (NICUs) and the benefits of parents' presence in improving preterm infants' recovery and development. It highlights the challenges in comparing and evaluating interventions supporting parenting in NICUs and the need for a systematic approach to assess their effectiveness. The Special Issue aims to provide a comprehensive overview of evidence-based interventions from Canada, Finland, and the USA, implemented globally, to enhance parenting and parents' involvement in NICU care. [Extracted from the article]

Aim: To explore the attitudes of parents and healthcare professionals (HCPs), and facilitators and barrier to implementation of Kangaroo Care (KC) in the United Kingdom. Methods: Online cross‐sectional survey; distributed via the British Association of Perinatal Medicine, Bliss (UK‐based charity), social media. Results: Sixty HCPs responded. 37 (62%) were nurses/nurse practitioners. 57 (95%) regularly implement KC. The most important factor that supported KC implementation was the team's belief in benefits of KC. Increased workload, staff shortage and fear about safely of KC in unwell infants were recognised as the challenges preventing implementation. Five hundred eighteen parents responded. 421 (81%) had a preterm baby within 3 years. 338 (80%) were familiar with KC. The main facilitator was the belief that their baby enjoyed it. Excess noise and crowding on the unit were the most frequently reported barriers. Lack of opportunity and limited staff support were the main reasons why they had been unable to practice KC. Conclusion: We found that most HCPs and parents believe that KC is beneficial and would like to practice it. Lack of resources to enable effective implementation is the main barrier. Service development and implementation research is required to ensure that KC is delivered in all UK neonatal units. [ABSTRACT FROM AUTHOR]

Aim: To investigate the diagnostic test accuracy of urine collection methods for urinary tract infections in outpatient children. Methods: A systematic literature review until April 2021 (Medline, Web of Science, Embase, Cinahl) to examine the diagnostic test accuracy of urine culture on collection methods for urinary tract infection in outpatient children below 18 years. Contamination rates were studied as secondary outcome. The risk of bias was assessed using the QUADAS‐2 criteria. Two‐by‐two tables were extracted in duplicate to calculate sensitivities, specificities, and likelihood ratios with 95% confidence intervals. Results: The search identified seven relevant studies. Clean catch compared to catheterization in children less than 90 days showed a sensitivity and specificity of 97% and 89% (95% CI: 84%–100% and 67%–99%), respectively. Adhesive bags compared to catheterization showed a sensitivity of 83% (95% CI: 75%–90%) and specificity of 91% (95% CI: 83%–96%). There was a similar diagnostic accuracy when comparing urine sampling by means of adhesive bags versus nappy pads. The contamination rate was 5% for clean catch, 30%–80% for adhesive bags and 64% for nappy pads. Conclusion: Nappy pads and adhesive bags are easy to use with comparable accuracy but are extremely prone to contamination. Clean‐catch urine sampling might be an accurate alternative in young infants in ambulatory care. [ABSTRACT FROM AUTHOR]

Aim: To understand which safe sleep recommendations parents find most challenging to implement, identifying common barriers encountered; and investigate whether challenges are associated with practices employed.Methods: A cross-sectional survey of 3341 Australian families with young infants who birthed a live baby during April-May 2017. Caregivers were asked about infant care practices and family characteristics. Qualitative free-text items explored challenges faced with current safe sleep recommendations.Results: Nearly one-third (n = 1033, 31%) of caregivers reported difficulty with at least one safe sleep recommendation. Infant sleep position and avoiding bed-sharing were identified as the most challenging recommendations. Caregivers described barriers which influenced consistency in uptake of advice. Families who described difficulty with a recommendation were significantly less likely to consistently employ that advice compared to those who did not report difficulty (sleep position: 198/473,42% vs 2548/2837,90% [p < 0.0001]; own sleep space: (269/344,78% vs 1331/2884,46% [p < 0.0001]). When families encountered challenges, they often proposed alternate strategies with an inference their substitute action compensated potential increased risk.Conclusion: Many families encounter difficulties implementing safe sleep advice; these challenges negatively impact care practices. Effective interventions meeting individual family needs, to provide safe sleep environments consistently, are necessary to improve sleep-related infant care and further reduce infant mortality. [ABSTRACT FROM AUTHOR]

Data evaluating mortality and morbidity in infants born ≤500 g are scarce and show wide variability. To support counselling and decision‐making, we analysed neurodevelopmental outcome in all neonates ≤500 g birth weight. Retrospective analysis including preterm infants with a birth weight ≤500 g and a gestational age >22 weeks born at a single tertiary perinatal centre between 2010 and 2017. Of 59 live births, 88% received standard care. Birth weight ranged from 318 to 500 g and gestational age from 23 to 29 weeks. 56% of neonates were born ≤3rd percentile and 42% of treated infants survived. Neurodevelopmental outcome was available in 91% of patients and was evaluated using Bayley Scales of Infant Development at two years. 50% showed a favourable mental development (normal or mild impairment), 75% a favourable motor development and 45% a favourable outcome in both outcome subcategories. When additionally considering visual and hearing disability and, or, cerebral palsy level ≥2 according to the Gross Motor Function Classification System 35% had a good neurodevelopmental outcome. Survival rate was 37% for all live births and 42% for infants with standard care. More than one‐third of survivors showed no significant neurodevelopmental impairment at two years. [ABSTRACT FROM AUTHOR]

Aim: Many countries lack monitoring of infant sleep practices, despite associations with sudden infant death. We studied sleep positions, bed-sharing and breastfeeding in a new birth cohort.Methods: Data were obtained from a prospective, population-based cohort study of children born in western Sweden in 2018. The parents of 9,465 six-month-old infants, via postal questionnaires, were asked about their infants' sleeping positions at three and six months, including where they slept and any bed-sharing arrangements. The data were compared with our earlier 2003-2004 birth cohort.Results: Questionnaires were completed by the parents of 3,590 (38%) infants. At three months, 54% of the infants slept in a separate cot in their parents' room. A further 43% slept in their parents' bed: 42% in baby nests and 42% in close contact with their parents. At six months, 33% bed-shared, compared with 20% in 2003-2004 (p < 0.001). Bed-sharing was positively associated with breastfeeding (odds ratio at three months: 1.5-2.8, 95% confidence interval: 1.1-4.5).Conclusion: Most infants slept in separate cots during the first three months. However, bed-sharing showed an increasing trend and baby nests were popular. Bed-sharing was positively associated with breastfeeding, but the association may not be causal. [ABSTRACT FROM AUTHOR]

Aim: We compared the impact of standard infant physiotherapy and the family‐centred programme, Coping with and Caring for Infants with Special Needs (COPCA), in infants born before 32 weeks without significant brain lesions. Methods: This randomised controlled trial was carried out in patients' homes and outpatient settings in Switzerland between January 2016 and October 2019. We used data from the national SwissNeoNet register and an assessment battery that included infant and family outcomes and video analyses of therapy sessions. The Infant Motor Profile was the primary outcome instrument. Results: The COPCA group comprised six boys and two girls with a median gestational age of 27 weeks (range 25‐30), and the standard care group comprised seven boys and one girl with a median gestational age of 29.5 weeks (range 26‐31). COPCA participants improved significantly more between baseline and 18 months in the IMP variation (9.0 percentage points, 95% confidence interval: 0.3‐17.5) and performance (12.0 percentage points, 95% confidence interval: 4.1‐20.6) domains than standard care participants. COPCA coaching was positively associated with IMP scores at 18 months, but some standard care actions were negatively associated. Conclusion: COPCA was associated with better motor outcome in infants born before 32 weeks than standard infant physiotherapy. [ABSTRACT FROM AUTHOR]

Aim: The knowledge is limited about how parents experience the time when their infant is receiving therapeutic hypothermia (TH) after severe perinatal asphyxia. The aim of this study was to explore parents' experience of closeness and involvement in their infant's care while in the neonatal intensive care unit (NICU) with their newborn undergoing TH. Methods: Face‐to‐face, semi‐structured interviews were conducted with parents (n = 11) whose infants (n = 8, aged 3‐5 years at the time of the study) underwent TH at a level III Swedish NICU during 2013‐2016. The interviews were analysed using qualitative content analysis. Results: All the parents shared the trauma of being both physically and psychologically separated from their infant. They all described a need for information and emotional support, and reported that the NICU staff had influenced the extent to which they as parents had been able to be near and actively participate in the care. Parents described the wish to be closer to their infant and to be more actively involved in their infant's care. Conclusion: Strategies to enable parent‐infant closeness and active guidance from staff might help alleviate the emotional stress of parents and promote their participation during TH. [ABSTRACT FROM AUTHOR]

Aim: The aim of this systematic review was to evaluate the clinical characteristics of COVID-19 in neonates and children under one year of age.Methods: A systematic literature review of the MEDLINE, PubMed, CINAHL, Embase and EBSCO databases was carried out for studies from January 1, 2020, to April 7, 2020. We included all papers that addressed clinical manifestations, laboratory results, imaging findings and outcomes in infants and neonates.Results: Our search identified 77 peer-reviewed papers, and 18 papers covering 160 infants were reviewed. One paper was from Vietnam, and the other 17 were from China: eight were cross-sectional studies, eight were case reports, one was a case series, and one was a prospective cohort study. The most common clinical symptoms were fever (54%) and cough (33%). Most infants were treated symptomatically, with frequent use of various empirical medications. Infants and neonates tended to have more severe COVID-19 disease than older children: 11 (7%) were admitted to intensive care and one infant died. The mortality rate was 0.006%, with favourable outcomes in most cases.Conclusion: Infants and neonates were more vulnerable to more severe COVID-19 disease than older children, but morbidity and mortality were low. [ABSTRACT FROM AUTHOR]

Aim: To assess, at national level, the implementation of eight principles for infant- and family-centred developmental care (IFCDC) in neonatal units. A European expert group established eight 'Principles of care' in 2018 that define neurodevelopmental and family-centred care.Methods: The implementation of each principle was assessed by a survey sent to level-III Spanish units. A principle was considered to be implemented if all answers to the principle-associated questions were positive.Results: The response rate was 84.5% (65/77). No unit had implemented eight principles. Principle 1 (free parental access) was implemented in 21.5% of the centres; Principle 2 (psychological support) 40%; Principle 3 (pain management) 7.7%; Principle 4 (environmental influences) 29%; Principle 5 (postural support) 84.6%; Principle 6 (kangaroo-care) 67.7%; Principle 7 (breastfeeding) 23% and Principle 8 (sleep protection) in 46%. In units attending ≥50 very low birth weight (VLBW) infants, four or more principles had been implemented in 31% vs 13% <50 VLBW neonates (odds ratio 3.0 CI 95% 0.9-10.1, P .07).Conclusion: The principle with the highest implementation was related to newborn body positioning. Pain management was the principle with lowest implementation. More principles for IFCDC tend to be implemented in units providing care for a higher number of VLBW infants. [ABSTRACT FROM AUTHOR]

As GP Posit integrates developmental care interventions, we documented the standards of care related to mother-infant relationship and inclusion of mothers in care and positioning. Care offered to preterm infants varies worldwide, ranging from less than essential lifesaving care to highly technological and neuroprotective care oriented towards survival with optimal outcomes. Documenting standard developmental care in neonatal intensive care units: Insights from the GP Posit pilot trial. [Extracted from the article]

The centralisation of neonatal intensive care in recent years has improved mortality, particularly of extremely preterm infants, but similar improvements in morbidity, such as neurodevelopmental impairment, have not been seen. Integral to the success of centralisation are specialised neonatal transport teams who provide intensive care prior to and during retrieval of high-risk neonates when in-utero transfer has not been possible. Neonatal retrieval aims to stabilise the clinical condition and then transfer the neonate during a high-risk period for patient. Transport introduces the hazards of noise and vibration; acceleration and deceleration forces; additional handling and temperature fluctuations. The transport team must stabilise the infant fully prior to transport as when on the move they are limited by space and movement to effectively attend to clinical deterioration. Inborn infants have better neurodevelopmental outcome compared with the outborn and aetiology of this seems to be multifactorial with the impact of transport itself during critical illness, remaining unclear. To improve the neurological outcomes for transported infants, it seems imperative to integrate the advancing intensive care neuromonitoring tools into the transport milieu. This review examines current inter-hospital transport neuromonitoring and how new modalities might be applied to the neurocritical care delivered by specialist transport teams. [ABSTRACT FROM AUTHOR]

Aim: To determine the relationship between clinical practice and publication of an Australian consensus statement for management of extremely preterm infants in 2006.Methods: A population-based study using linked data from New South Wales, Australia for births between 22 + 0 and 26 + 6 weeks of gestation between 2000 and 2011.Results: There were 4746 births of whom 2870 were liveborn and 1876 were stillborn. Of the live births, 2041 (71%) were resuscitated, 1914 (67%) were admitted into a neonatal intensive care unit (NICU) and 1310 (46%) survived to hospital discharge. Thirty-nine (2%) stillbirths were resuscitated but none survived. No 22-week infant survived to hospital discharge. Fewer 23-week gestation infants were resuscitated between 2004 (52%) and 2005 (20%) but resuscitation rates increased by 2008 (44%). There was no difference at other gestations. Adjusted odds ratio (OR) for resuscitation was increased by birthweight (OR: 1.01), tertiary hospital birth (OR: 3.4) and Caesarean delivery (OR: 11.3) and decreased by rural residence (OR: 0.4) and male gender (OR: 0.7).Conclusion: Expert recommendations may be shaped by clinical practice rather than the converse, especially for 23-week gestation infants. Recommendations should be revised regularly to include clinical practice changes. [ABSTRACT FROM AUTHOR]

Aim: The aim was to compare growth in very premature infants cared for in a single-family room (SFR) and an open-bay (OB) unit. We recorded duration of parental presence and skin-to-skin contact as proxies for parental involvement in care of their infants.Methods: We consecutively included infants with gestational ages 28 + 0 through 32 + 0 weeks at two hospitals in Norway, one SFR unit (n = 35) and one OB unit (n = 42). Weight, length, and head circumference were followed from birth to four months after term date. Both units adhered to the same nutritional protocol and methods of recording events.Results: The SFR mothers spent a mean (standard deviation) of 111 (38) hours and the OB mothers 33 (13) hours with their infants during the first week and 21 (5) versus 7 (3) hours per day later. The respective duration of skin-to-skin care was 21 (10) versus 12 (8) hours during the first week and 4.2 (2) versus 3.0 (2) hours per day later. The differences were similar, but less pronounced for the fathers. The growth trajectories did not differ between the groups.Conclusion: SFR care was associated with more parental involvement, but not with better growth. [ABSTRACT FROM AUTHOR]

Aim: We determined the safety, feasibility and sustainability of an outpatient model of care for infants exposed to intra-uterine drugs.Methods: This was a retrospective chart review of 774 drug-exposed infants born between 1998 and 2016 at the Royal Hospital for Women, Sydney, Australia.Results: Most (86%) of the mothers used multiple drugs, including opioids (58%). More than three-quarters (78%) of the infants were born full term at a mean gestation of 38 weeks and hospitalised for a median of seven days. This rose to 14 days if they were medicated for neonatal abstinence syndrome (NAS). Most of the NAS patients (83%) were discharged on medication, namely morphine, and the median duration of NAS treatment was 76 (interquartile range 35-120). Three medication errors occurred: two extra doses of phenobarbitone and one infant weaned off morphine faster than prescribed. No infants were rehospitalised for NAS. Four died from sudden infant death syndrome at 2.2-5.8 months after discharge and one drowned at 15 months. None were medicated at the time of death.Conclusion: Outpatient care for drug-exposed infants was sustainable and had low complication rates, even for those with NAS. The optimum duration of follow-up and impact on hospital costs should be examined. [ABSTRACT FROM AUTHOR]

Aim: We used ultrasound to evaluate renal swelling as a predictor of acute and permanent renal damage in infants with their first urinary tract infection (UTI).Methods: The cohort at the Queen Silvia Children's Hospital, Gothenburg, Sweden, comprised 101 infants with their first UTI at a mean age of 3.9 ± 3.0 months. Acute and follow-up ultrasounds were carried out a few days and one month after treatment started, and a 99m technetium dimercaptosuccinic acid (DMSA) scan was carried out after one month and after a year if the first scan was abnormal.Results: The acute ultrasounds showed that renal length and volume, calculated as standard deviation scores (SDS), were 1.39 ± 1.43 SDS and 1.30 ± 1.08 SDS. We found that 52% of the one-month DMSA scans and 25% of the one-year DMSA scans were abnormal. Renal length (p = 0.0026) and initial volume (p = 0.0005) on the ultrasound predicted acute renal damage at the one-month DMSA scan and initial renal length (p = 0.030) predicted permanent renal damage at the one-year DMSA scan.Conclusion: Renal swelling was associated with renal damage. Although the diagnostic performance compared with the DMSA scan was weak, renal swelling may help clinicians to make decisions about further investigations and follow-ups of infants with UTIs. [ABSTRACT FROM AUTHOR]

Aim: Neonatal hypothermia is a preventable cause of neonatal mortality and morbidity, and wrapping neonates in newspaper sandwiched between cotton sheets is a simple intervention. This 2017 Indian pilot study tested the heat insulating property of sandwiched sheets.Methods: At birth, we randomised 100 neonates who were more than 32 weeks of gestation and needed neonatal intensive care unit (NICU) observation or care without a ventilator or bilevel positive airway pressure support into two groups of 50. The intervention and control groups were wrapped in two prewarmed sheets at birth that did or did not contain a layer of newspaper. Their axillary temperatures on arrival at the NICU and one hour after arrival were measured. Other environmental factors were similar.Results: The neonates wrapped in the sandwiched sheets showed significantly higher temperatures on arrival at the NICU than the control group (35.9°C versus 35.4°C, p < 0.01) and after one hour (36.5°C versus 36.3°C, p < 0.01). No change in behaviour or training was required for the healthcare staff to implement this initiative.Conclusion: Wrapping newborn infants in two cloth sheets with a newspaper layer resulted in a higher body temperature on arrival at the NICU and after one hour. [ABSTRACT FROM AUTHOR]

Aim: To determine whether high intake of intralipid (IL) in extremely low birthweight (ELBW) neonates is associated with higher rates of neuroimpairment and Bayley III scores at two years of corrected age.Methods: Quartiles of IL received by 389 ELBW infants were linked to neurodevelopmental outcomes. Logistic regression analyses, adjusted for confounders, were performed to determine the association between IL dose and neuroimpairment. Linear regression analyses were performed to predict Bayley III scores.Results: No association was found between IL dose and neuroimpairment A significant association was found between higher IL intake and lower Bayley Cognitive, motor and language scores. Adding breast milk intake to the linear regression eliminated the associations.Conclusion: Higher IL intake was associated with lower cognitive, motor and language scores. Breast milk intake eliminated the latter associations, which underscores the important role of breast milk in developmental outcome. [ABSTRACT FROM AUTHOR]

Aim: Premature delivery and maternal separation during hospitalisation increase infant neurodevelopmental risk. Previously, a randomised controlled trial of Family Nurture Intervention (FNI) in the neonatal intensive care unit demonstrated improvement across multiple mother and infant domains including increased electroencephalographic (EEG) power in the frontal polar region at term age. New aims were to quantify developmental changes in EEG power in all brain regions and frequencies and correlate developmental changes in EEG power among regions.Methods: EEG (128 electrodes) was obtained at 34-44 weeks postmenstrual age from preterm infants born 26-34 weeks. Forty-four infants were treated with Standard Care and 53 with FNI. EEG power was computed in 10 frequency bands (1-48 Hz) in 10 brain regions and in active and quiet sleep.Results: Percent change/week in EEG power was increased in FNI in 132/200 tests (p < 0.05), 117 tests passed a 5% False Discovery Rate threshold. In addition, FNI demonstrated greater regional independence in those developmental rates of change.Conclusion: This study strengthens the conclusion that FNI promotes cerebral cortical development of preterm infants. The findings indicate that developmental changes in EEG may provide biomarkers for risk in preterm infants as well as proximal markers of effects of FNI. [ABSTRACT FROM AUTHOR]

Aim: Our aim was to study the development of the cutaneous flexion withdrawal reflex among premature infants admitted to the neonatal intensive care unit of the Children's Hospital, University of Cologne, in 2013.Methodology: This longitudinal cohort study explored the development of spinal cord excitability of 19 premature infants born at 22-26 weeks of gestation. We performed five investigations per subject and studied changes in the reflex threshold with increasing postnatal age at different behavioural states. The premature infants were stimulated with von Frey filaments on the plantar surface of the foot near the first metatarsophalangeal joint during the first 3 days of life and at postnatal ages of 10-14 days, 21-28 days, 49-59 days and a corrected gestational age of 37-40 weeks.Results: The mean gestational age of the premature infants included in the study was 24 weeks. Premature infants with a gestational age of less than 26 weeks presented a flexion withdrawal reflex with a low threshold (0.5-2.85 milli-Newton) in the first 72 hours of life.Conclusion: The flexion withdrawal reflex among premature infants born at less than 26 weeks showed a continuous threshold increase with increasing postnatal age, reflecting changes in spinal cord excitability. [ABSTRACT FROM AUTHOR]

Aim: Little is known about the amount of physical parent-infant closeness in neonatal intensive care units (NICUs), and this study explored that issue in six European countries.Methods: The parents of 328 preterm infants were recruited in 11 NICUs in Finland, Estonia, Sweden, Norway, Italy and Spain. They filled in daily diaries about how much time they spent in the NICU, in skin-to-skin contact (SSC) and holding their babies in the first two weeks of their hospitalisation.Results: The parents' NICU presence varied from a median of 3.3 (minimum 0.7-maximum 6.7) to 22.3 (18.7-24.0) hours per day (p < 0.001), SSC varied from 0.3 (0-1.4) to 6.6 (2.2-19.5) hours per day (p < 0.001) and holding varied from 0 (0-1.5) to 3.2 (0-7.4) hours per day (p < 0.001). Longer SSC was associated with singleton babies and more highly educated mothers. Holding the baby for longer was associated with gestational age. The most important factor supporting parent-infant closeness was the opportunity to stay overnight in the NICU. Having other children and the distance from home to the hospital had no impact on parent-infant closeness.Conclusion: Parents spent more time in NICUs if they could stay overnight, underlining the importance that these facilities play in establishing parent-infant closeness. [ABSTRACT FROM AUTHOR]

Unlabelled: The development of human milk banks in Muslim countries is challenging because of the tradition of milk kinship. In other countries, this tradition imposes restrictions on Muslim mothers with regard to donating their milk or receiving donor milk for their preterm baby. However, Muslim law does allow the use of donated human milk under certain conditions, for example if it comes from a single known donor or is pooled from the milk of at least three donors.Conclusion: Muslim parents need to be made aware that human milk banks can be used for preterm babies if strict conditions are met. [ABSTRACT FROM AUTHOR]

The article offers information on methicillin-resistant Staphylococcus aureus (MRSA) and aims to study risk factors for transmission of MRSA infections in children in Switzerland. The study collected isolates from patients with MRSA infections and pulsed-field gel electrophoresis (PFGE) typing was performed to find isolate. It mentions that the Panton-Valentine leukocidin (PVL) genes lukSF-PV of isolates was confirmed.

Aim High-flow nasal cannulae ( HFNC) are increasingly used for respiratory management of preterm infants. However, their ability to provide support compared to nasal continuous positive airway pressure ( CPAP) has been questioned. We compared the effect of HFNC versus nasal CPAP on diaphragm electrical activity ( EAdi) in preterm infants. Methods Preterm infants ≤1500 g were randomised in a crossover design to receive 2 hours of either Infant Flow® CPAP ( IF- CPAP) at 5-6 cmH2O or HFNC with the flow rate adjusted to achieve an equivalent pharyngeal pressure. A feeding catheter with miniaturised sensors was inserted for continuous EAdi measurement. Results The study comprised ten infants. Physiologic parameters and oxygen requirements were not different between the two modes. However, seven infants demonstrated a higher EAdi peak and six showed a higher EAdi tonic on HFNC, even though the mean group data showed no difference between HFNC and IF- CPAP. Neural inspiratory time was significantly longer with HFNC than IF- CPAP (0.55 ± 0.11 versus 0.48 ± 0.06 seconds, p = 0.018). Conclusion In this cohort of preterm infants, the majority exhibited greater diaphragm activation, as assessed by neural breathing patterns, when supported with HFNC than IF- CPAP, suggesting that nasal CPAP may provide more effective respiratory support. [ABSTRACT FROM AUTHOR]

Gastrointestinal symptoms, such as constipation, regurgitation and infant colic, occur in about half of infants. These symptoms are often functional, but they may also be caused by cow's milk protein allergy. We developed three algorithms for formula-fed infants, which are consensus rather than evidence-based due to the limited research available in the existing literature. Conclusion: We believe that these algorithms will help primary healthcare practitioners to recognise and manage these frequent gastrointestinal manifestations in infants. [ABSTRACT FROM AUTHOR]

Aim It is important to identify speech and language difficulties in children as early as possible. This study investigated the validity of observing babbling structure and consonant articulation. Methods We focused on the language capabilities of children, with and without cleft palates, at 12 months of age (n = 29) and 18 months of age (n = 38), comparing observations made by speech and language pathologists on babbling structure and consonant articulation to audio recordings phonetically transcribed by experts blinded to the aim of the study. Descriptive cross-tabs, sensitivity, specificity and predictive values were analysed to investigate the validity of agreement between the methods. Results We found high mean agreement between the two methods (94%) and within the observation (100%) and transcription (88.5%) teams when it came to canonical babbling, high-pressure/oral stop consonants and anterior placement of bilabial and dental/alveolar consonants. The observations had high specificity and negative predictive values (0.90-1) at both ages, with low to moderate sensitivity (0-0.86). However, there was low agreement, between and within the groups, on the number of consonant types and the unproven predictive variable glottal place of articulation. Conclusion Previously suggested predictive measures of babbling were shown to be valid and observation is a reliable method of identifying children who need further support. [ABSTRACT FROM AUTHOR]

Infants suffering from neonatal sepsis face an increased risk of early death and long-term neurodevelopmental delay. This paper analyses and summarises the existing data on short-term and long-term outcomes of neonatal sepsis, based on 12 studies published between January 2000 and 1 April 2012 and covering 3669 neonates with sepsis. Conclusion Infants who have suffered neonatal sepsis face an increased risk of mortality and severe complications such as brain damage and, or, neurodevelopmental delay. [ABSTRACT FROM AUTHOR]

Aim This study examined the need for, and timing of, major medical interventions ( MMIs) in infants under 6 months of age with bronchiolitis. Methods We reviewed the medical records of 353 children who visited our emergency department with bronchiolitis. MMI was defined as the need for any of the following interventions during admission: supplementary oxygen, intravenous fluids, intravenous antibiotics or admission to the intensive care unit. Results Altogether 19% of the 353 patients required a MMI and 3% had apnoea. The patients with apnoea were all under 2 months of age, and 90% had a respiratory syncytial virus ( RSV) infection and 40% had been born prematurely. The risk of needing a MMI continued for up to 5 days after disease onset. A positive RSV test predicted a MMI with an odds ratio ( OR) of 11.5 (95% CI 2.6-50.5), and a fever of over 38°C predicted a MMI with an OR of 3.5 (95% CI 1.4-8.8). Each 1% increase in the initial oxygen saturation value was associated with a decreased risk of MMI ( OR 0.7, 95% CI 0.6-0.8). Conclusion Infants under 6 months of age with bronchiolitis were most likely to need MMIs in the first 5 days after disease onset. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to evaluate the uptake of a free vitamin D infant prescription programme and to determine the incidence of nutritional rickets. Methods This was a retrospective cohort study of infants from Quebec, Canada, involving term infants born between 1998 and 2008 and covered by the public insurance programme. Data were extracted from the Quebec Pregnancy Cohort. Predictors of programme participation were identified through logistic regression. Results A total of 123 018 infants were eligible, and the mean annual prevalence of supplemental vitamin D exposure was 17.9 ± 5.6%. The median age for obtaining the first bottle was 36 days and half only obtained one bottle of 50 doses. Mothers with higher socio-economic status, those who lived as a couple, older mothers or a prescription by a paediatrician significantly increased the odds of obtaining vitamin D. There was a decline in programme participation over time ( OR 0.89/year, 95% CI = 0.88-0.90). The incidence of rickets was 23.9 cases per 100 000 live births, with an annual increase of 1.12 cases/year (95% CI = 1.01-1.24). Conclusion Without educational measures, a free prescription programme for vitamin D failed to encourage participation or adherence. Moreover, participation decreased with time. New strategies, including educational support, need to be developed to increase vitamin D supplementation rates. [ABSTRACT FROM AUTHOR]

Aim Kangaroo care ( KC) and maternal singing benefit preterm infants, and we investigated whether combining these benefitted infants and mothers. Methods A prospective randomised, within-subject, crossover, repeated-measures study design was used, with participants acting as their own controls. We evaluated the heart rate variability ( HRV) of stable preterm infants receiving KC, with and without maternal singing. This included low frequency ( LF), high frequency ( HF) and the LF/ HF ratio during baseline (10 min), singing or quiet phases (20 min) and recovery (10 min). Physiological parameters, maternal anxiety and the infants' behavioural state were measured. Results We included 86 stable preterm infants, with a postmenstrual age of 32-36 weeks. A significant change in LF and HF, and lower LF/ HF ratio, was observed during KC with maternal singing during the intervention and recovery phases, compared with just KC and baseline (all p-values <0.05). Maternal anxiety was lower during singing than just KC (p = 0.04). No differences in the infants' behavioural states or physiological parameters were found, with or without singing. Conclusion Maternal singing during KC reduces maternal anxiety and leads to autonomic stability in stable preterm infants. This effect is not detected in behavioural state or physiological parameters commonly used to monitor preterm infants. [ABSTRACT FROM AUTHOR]

Aim To evaluate the effectiveness of chest physiotherapy ( CPT), which provides slow and long expiratory flow and assisted cough techniques, in infants receiving outpatient care for acute wheezing episodes. Methods Forty-eight infants with moderate acute wheezing episodes were randomised to receive either salbutamol MDI with CPT (n = 25) or without CPT (n = 23). The clinical score and SpO2 levels were recorded, before and after treatment, in a blinded design. The primary outcome was discharge after the first hour of treatment: clinical score ≤5/12 and SpO2 ≥ 93%. Secondary outcomes were the number of admissions to hospital after the second hour, use of oral corticosteroid bursts and admissions to hospital on day seven. Results There were no differences between children with and without CPT in discharge rate (92% vs. 87%), clinical score (median [ IQR]: 2.8 [2.2-3.3] vs. 3.4 [2.8-4.1]) and SpO2= (96.4 [95.7-97.1] vs. 96.0 [94.9-96.5]) after the first hour of treatment or in the number of hospital admissions after the second hour. No differences were observed at days seven and 28 following treatment. Conclusion There was no evidence of clinical benefits from these specific CPT techniques for infants receiving outpatient care for acute wheezing episodes. [ABSTRACT FROM AUTHOR]

Aim To investigate the effect of the Guided Family- Centred Care intervention, developed by the lead author, on parental stress in a neonatal intensive care unit ( NICU). Methods Parents (n = 134) of infants born ≤34 weeks gestational age were randomly assigned to a standard care group (n = 60) or intervention group (n = 74) between April 2011 and August 2012. Guided Family- Centred Care components used were as follows: scheduled nurse-parent dialogues, semi-structured reflection sheets and person-centred communication. Parental stress was assessed at discharge using parent-reported outcomes on the Nurse Parent Support Tool and the Parental Stressor Scale: Neonatal Intensive Care Unit. Results The total stress scores reported by parents did not vary significantly between the intervention and standard groups, with a mean (SD) of 2.70 (0.67) versus 2.84 (0.71), respectively. However, the confidence interval included the prespecified clinical significance level. Subscale and Nurse Parent Support Tool scores did not differ between the groups. Overall, mothers reported more stress than fathers (p < 0.001). Conclusion Our study was unable to demonstrate the effect of person-centred communication using the Guided Family- Centred Care intervention. It may be necessary to replicate the design to address the risk of contamination and add instruments sensitive to human interaction. [ABSTRACT FROM AUTHOR]

Aim Infant feeding affects growth, obesity and life-long health. This study examined the impact of dietary patterns on body mass index (BMI) at 12 and 18 months. Methods We followed a cohort of 2666 children recruited in 2007-2008. Feeding practices were obtained from parental questionnaires and anthropometric data collected by child health nurses. Results At 6 months, 58.3% of the infant were breastfed, but only 1.6% exclusively. Many had begun eating solids (91.8%), porridge (87.7%) or milk cereal drink (46.6%). Bottle-feeding at 4 months was not a risk factor for a high BMI (>1 SD) at 12 or 18 months. Milk cereal drink at six months increased the risk of a high BMI at 12 and 18 months, respectively (OR 1.58, 95% CI 1.12-2.22, and 1.52, 1.07-2.17). Milk cereal drink use was increased by low parental education and maternal obesity and reduced by troubled sleep and parental group participation. Conclusion Formula at 4 months did not predict a high BMI at 12 or 18 months. Milk cereal drink use at 6 months was a risk factor for a high BMI at 12 and 18 months. The choice of milk cereal drink was influenced by parental factors, especially educational levels. [ABSTRACT FROM AUTHOR]

Aim To investigate the circumstances surrounding end-of life decisions ( Eo L) of infants with hypoxic-ischaemic encephalopathy ( HIE) and examine changes over a 10-year period. Methods Retrospective chart review of all infants with HIE who died during 2000-2004 and 2005-2009 in a Level III Neonatal Intensive Care Unit in Madrid, Spain. Results Of 70 infants with HIE, 18 died during the neonatal period. The mean age of death was 64.4 ± 51 h. In 17 of the 18 infants (94%), death was preceded by an Eo L decision, four after withholding therapy ( WH) and 13 after withdrawal therapy ( WDT). All infants with WH were previously stable and without respiratory support, while all 13 infants in the WDT group had respiratory support and three were unstable. The age of death was greater in the WH group than the WDT group (122 ± 63 h vs 50 ± 34; p < 0.001). After the Eo L decision, 11 (65%) infants received sedatives. There were no differences between the time periods. Conclusion In our cohort, most deaths in newborns with HIE were preceded by Eo L decisions mainly within the first 3 days after birth. We did not find changes over the first decade of the 21st century, and death was mainly determined by WDT. [ABSTRACT FROM AUTHOR]

Aim Infection is an important cause of neonatal and infant mortality. We evaluated changes in infant deaths from infections from 1988 to 2008 in the North of England. Methods We interrogated a population-based survey and reviewed infant deaths from infection. Proportional contribution to deaths, pathogens identified and risk factors were analysed. Results Thirteen percentage of 4366 infant deaths from a population of 704 536 livebirths were infectious. The absolute numbers of infant deaths from infection fell over time but the proportion of deaths from infection increased (12.1%, 13.6% and 14.9%). Significantly preterm infants were increasingly represented in successive epochs (14%, 24% and 38%). Infant mortality rate ( IMR) from meningococcus and Group B Streptococcus ( GBS) fell in the latest epoch, but there was a corresponding increase from Escherichia coli and candida. Discussion This large study shows that infections have become proportionately more important causes of death especially in very preterm infants. Recent significant reductions in death from meningococcus and GBS are likely to represent successful achievements of vaccination and antibiotic prophylactic policies. Increases in IMR from E. coli may relate to GBS prophylaxis and increases in candida to the increase from preterm populations. Further efforts to understand these changing patterns and develop additional prevention and treatment strategies and vaccines remain an urgent priority. [ABSTRACT FROM AUTHOR]

Aim To compare the early post-natal pattern of systemic inflammation in growth-restricted infants born before the 28th week of gestation to that of appropriately grown peers. Methods We measured the concentrations of 25 inflammation-related proteins in blood spots collected from 939 newborns during the first 2 post-natal weeks. We calculated the odds ratios (99% confidence intervals) that concentrations would be in the highest quartile. Results Severely growth-restricted infants (birth weight Z-score <−2) were not at increased risk of systemic inflammation shortly after birth. On post-natal day 14, however, they were significantly more likely than their peers to have a CRP, IL-1β, IL-6, TNF-α, IL-8, MCP-4, ICAM-1, ICAM-3, E- SEL, MMP-9, VEGF-R2 and/or IGFBP-1 concentration in the highest quartile. These increased risks could not be attributed to delivery indication, bacteremia or duration of ventilation. Conclusion Growth-restricted preterm newborns appear to be at increased risk of elevated concentrations of inflammation-associated proteins by post-natal day 14. [ABSTRACT FROM AUTHOR]

Aim: To evaluate fluctuations in anti-Xa concentrations in infants treated with enoxaparin for thrombosis and describe clinical outcomes. Methods: A retrospective chart review was performed on infants treated with enoxaparin in the Neonatal Intensive Care Unit, and data on enoxaparin doses, anti-Xa concentrations, clinical characteristics and outcomes were abstracted. Results: Our cohort (n = 26) had a median gestation of 36 (range, 23-41) weeks, birthweight of 2522 (510-3912) grams and 5-min Apgar score of 8(4-9). Fifteen (57.7%) infants were males. Thromboses was diagnosed at a median age of 22 (range, 1-97) days; enoxaparin was initiated at 27.5 (range, 4-98) days at a mean (SD) dose of 1.4 (0.3) mg/kg every 12 h. Therapeutic anti-Xa concentrations (0.5-1 U/mL) were achieved at a mean (SD) dose of 2.1 (0.6) mg/kg at 12.5 (12.2) days of treatment. Of the 143 anti-Xa concentrations, 39 (27%) were within the therapeutic range. During maintenance therapy following initial therapeutic anti-Xa concentration, 40% concentrations were therapeutic. Minor bleeding was noted in four infants and intracranial bleed in one infant; four infants died. During treatment, thrombocytopenia, renal and hepatic impairment during treatment were noted in 7, 2 and 4 infants, respectively. Clot resolution was observed in 21 (81%) infants. Conclusions: Anti-Xa concentrations fluctuate during maintenance enoxaparin therapy, with therapeutic levels being achieved only sporadically in young infants. Despite this, enoxaparin appears efficacious in thrombosis resolution. Further studies on the impact of stringent control of concentrations on outcomes in this population are warranted. [ABSTRACT FROM AUTHOR]

Aim: To quantify the cost and prediction of futile care in the Neonatal Intensive Care Unit (NICU). Methods: We observed 1813 infants on 100 000 NICU bed days between 1999 and 2008 at the University of Chicago. We determined costs and assessed predictions of futility for each day the infant required mechanical ventilation. Results: Only 6% of NICU expenses were spent on nonsurvivors, and in this sense, they were futile. If only money spent after predictions of death is considered, futile expenses fell to 4.5%. NICU care was preferentially directed to survivors for even the smallest infants, at the highest risk to die. Over 75% of ventilated NICU infants were correctly predicted to survive on every day of ventilation by every caretaker. However, predictions of 'die before discharge' were wrong more than one time in three. Attendings and neonatology fellows tended to be optimistic, while nurses and neonatal nurse practitioners tended to be pessimistic. Conclusions: Criticisms of the expense of NICU care find little support in these data. Rather, NICU care is remarkably well targeted to patients who will survive, particularly when contrasted with care in adult ICUs. We continue to search for better prognostic tools for individual infants. [ABSTRACT FROM AUTHOR]

Breastfeeding has been associated with multiple developmental advantages for the infant; however, there have also been a number of studies that find no significant benefits to child development. We examined the relationship between breastfeeding for 4 months or longer and child development at age 1, 2 and 3 years. Women were enrolled in the Western Australian Pregnancy Cohort (Raine) Study (N = 2900) and their live born children (N = 2868) were followed to the age of 3 years (N = 2280). Infant feeding data were collected at each age, and the mothers completed the Infant/Child Monitoring Questionnaire (IMQ), which measures progress towards developmental milestones in the domains of gross and fine motor skills, adaptability, sociability and communication. Factors adjusted for in multivariable analyses included maternal sociodemographic characteristics and stressful life events. Infants breastfed for 4 months or longer had significantly higher mean scores (representing better functioning) for fine motor skills at age 1 and 3, significantly higher adaptability scores up to age two, and higher communication scores at age 1 and 3 years. Infants who were breastfed for <4 months were more likely to have at least one atypical score across the five developmental domains than those who were breastfed for 4 months or longer. Although our effect sizes were small, breastfeeding for 4 months or longer was associated with improved developmental outcomes for children aged one to 3 years after adjustment for multiple confounding factors. [ABSTRACT FROM AUTHOR]

To assess the main determinants of the newborn's nosocomial olfactory environment. An electronic questionnaire was sent to 99 neonatal units in France. Senior nurses and/or physicians described the nature and use of skin care products (e.g. umbilical cord and skin disinfectants, adhesive removers), lubrications used for tubes positioning, disinfectants used to clean materials, hand hygiene products (e.g. alcohol-based hand rubs, soaps) and newborns' bath. Nine groups of products and 76 distinct commercial preparations were identified. Depending on their level of respiratory support, preterm newborns were estimated to be exposed to nosocomial odours (NO) an average of 1320-1800 times during their first month of life. During their whole hospital stay, newborns of 28 and 32 weeks of gestational age could be exposed to NOs products an average of 3448 and 2024 times, respectively. The use of these products varied among medical centres. Newborns were most frequently exposed to the odour of aqueous alcoholic solutions. Vulnerable preterm infants are daily exposed to multiple NOs most of them be considered as irritant for the nose. Minimizing infants' exposure to them would be beneficial. Future studies should describe the exact olfactory properties of the products considered essential for infant care and should assess their effects on the infant's well-being and development. [ABSTRACT FROM AUTHOR]

In spite of several reports of an increased risk of sudden infant death syndrome (SIDS) in connection with bed-sharing, it is not an uncommon practice. The aim of this study was to examine bed-sharing at 6 months of age and the factors that are associated with bed-sharing. Our cohort comprised 8176 randomly chosen families. At 6 month of age, the families received an invitation to the study, with a questionnaire, which was completed by 5605 families (response rate 68.5%). Of the families, 19.8% bed-shared. In the multivariate analysis, we found a correlation between breast-feeding and bed-sharing (breast-feeding at 6 months: OR 1.94; 95% CI 1.56, 2.41). Moreover, we found an association with 3+ nightly awakenings at 6 months (2.70; 2.20, 3.32). It was more common to share a bed if the parent was single (2.04; 1.19, 3.51) and less common if the infant was bottle-fed in the first week (0.70; 0.54, 0.90). Never using a pacifier was associated with a higher frequency of bed-sharing. We found a correlation between breast-feeding and bed-sharing as well as between sleeping problems and a single parent. A lower percentage of infants sleeping in the parental bed were seen in association with formula feeding in the first week after birth. [ABSTRACT FROM AUTHOR]